The Development Of Insulin Injection Fear Questionnaire For Diabetic Patients

Objective:To develop the Questionnaire on Fear of Insulin Injection in Diabetic Patients and test its reliability and validity,so as to provide an assessment tool for assessing the fear of insulin injection in diabetic patients.Method:1.Based on the CPT theoretical model of stress proposed by Lazarus,this study searched literature related to insulin injection in diabetic patients in domestic and foreign databases,and preliminarily established the item pool of insulin injection fear questionnaire in diabetic patients based on the results of semi-structured interviews with patients.2.Fifteen experts in this research field were invited to conduct two rounds of Delphi expert consultation,and 30 patients were selected for pre-investigation,and the initial questionnaire of "Fear Questionnaire of Insulin Injection in Diabetic Patients" was obtained.3.From September 2020 to January 2021,360 diabetic patients with insulin injection were investigated by using the initial questionnaire of "fear of insulin injection in diabetic patients ",and its reliability and validity were tested.The specific methods are as follows:(1)Questionnaire item screening:①The sensitivity of items was detected by coefficient of variation method;②the critical ratio method is used to detect the distinction of items;③Correlation coefficient method was used to detect the independence and representativeness of items;④Cronbach’sa coefficient method was used to detect the internal consistency of items.(2)Questionnaire validity evaluation:①Structural validity(exploratory factor analysis)was selected to detect the corresponding relationship between items and factors;②The content validity(expert judgment method)was selected to judge the applicability of the questionnaire.(3)Questionnaire reliability evaluation:internal consistency Cronbach’s a coefficient and odd-even split half reliability coefficient were selected to test the internal consistency of the questionnaire.Result:1.By reviewing relevant literatures and conducting semi-structured interviews with patients,37 questionnaire item pools were preliminarily formed,including 6 dimensions,namely physiological fear,anticipated difficulties,fear of life change and restriction,fear of treatment consequences,fear of stigma,and coping style.2.Through 2 rounds of consultation with experts(15 in total),a dimension was merged,8 items were deleted,3 items were added,and 11 items were modified to form an initial questionnaire with 32 items.The questionnaire contains five dimensions,which are physiological fear,fear of treatment conflict choice,fear of inconvenience and stigma,fear of treatment consequences,and coping style.3.Entry screeningThe coefficient of variation method,critical ratio method,correlation coefficient method and Cronbach’s a coefficient method were used to screen the items,and 1 item was deleted.4.Reliability test4.1 The Cronbach’s a coefficient of the internal consistency reliability of this questionnaire is 0.924,and the Cronbach’s a coefficient of each dimension is 0.929,0.939,0.827 and 0.902,respectively.4.2 The half-fold reliability coefficient of this questionnaire is 0.799,and the half-fold coefficients of each dimension are 0.926,0.898,0.738 and 0.757,respectively.5.Validity test5.1 Content validity:①The item content validity index I-CVI of this questionnaire ranged from 0.80 to 1.00;②The content validity index S-CVI/AVE at the scale level was 0.92.5.2 Structural validity:After three exploratory factor analyses,9 items were deleted and 4 common factors were extracted.The cumulative contribution rate was 74.282%,and the factor load of all items was≥0.4.Four dimensions and 22 items of formal questionnaire were finally formed,including self-fear(6 items),fear of therapeutic conflict choice(10 items),fear of stigma(3 items),and coping style(3 items)Conclusion:In this study,stress theory was used as the theoretical basis for questionnaire preparation,and the structural framework of questionnaire on fear of insulin injection in diabetic patients was constructed.Through literature review,qualitative interview,expert consultation,and reliability and validity test,the formal questionnaire "Fear of Insulin Injection in Diabetic Patients" with 4 dimensions and 22 items was finally formed.The questionnaire included four dimensions:physiological fear,fear of therapeutic conflict choice,fear of stigmatization,and coping style.Dimensions and items can reflect the content requirements of the stress CPT theoretical model,and can reflect the fear response and coping style of diabetic patients to the event of insulin injection.The questionnaire can be used as an evaluation tool to evaluate the degree of insulin fear in diabetic patients as it with good reliability and validity and the process is standardized and the content is reasonable.